Chapter 1 of Getting It Done presents a scenario in which an ICU medical director felt the need for increased hospital recognition of sepsis (overwhelming bacterial infection) and mobilized mid-level managers, nurses, physicians, and senior administrators to work more interdependently to improve diagnosis and treatment as part of a Slaying Sepsis campaign.
Research had shown that early identification of the signs and symptoms of a patient’s presentation in the Emergency Department (ED) and rapid implementation of a clearly defined clinical protocol could reduce the likelihood of death due to sepsis. While the majority of patients suffering from sepsis venture through the ED, patients also develop sepsis on patient care floors. Thus, all parties needed to be trained to recognize the signs and symptoms of sepsis, so that treatment can be administered within one hour of presentation.
The medical director brought together all the parties necessary to assure a smooth and rapid improvement process, enlisting the resources of the organization in order to secure buy-in and support to reduce death due to sepsis. All of these actions occurred without going through medical staff committees, obtaining consensus of physicians practicing in the adult critical care units, or “asking permission” of nursing or administration. There was a need, the medical director was passionate about responding, and the process took off.
The strengths on which he built are found in hospitals throughout the US:
- A committed staff
- Clinically savvy physicians who made themselves available, especially in the golden hour from the time of patient presentation until fluids and antibiotics were administered
- Precedents for interdisciplinary collaboration at his hospital in trauma and cancer care, for example
- An active, engaged senior management and Board
He used innovative strategies, including a:
- Specially marked tube top that identified blood specimens from the sepsis protocol, that go to the front of the queue, to overcome slow turnaround times
- Module attached to the blood-gas machine to measure arterial lactate levels within 10 minutes
- Sepsis cart in the Medical ICU that contained everything patients needed, to keep the patient’s nurse at the bedside as much as possible
Within two years, the annual death rate from sepsis decreased from 44% to 24% without a single drug being changed. The results were stunning to the medical staff, the nursing staff, administration and the Board of Directors. However, two years later, the death rate climbed to 27%, spurring alarm. The medical director pulled the entire team together and spent a weekend in a Lean-guided approach, using root-cause analyses and a just-in-time approach to minimize waste and optimize efficiency and effectiveness.
The team identified changes that were necessary, implemented the changes, and reduced the annual sepsis mortality rate to less than 20%. An estimated 200 people are alive today as a result of the process improvements, who would not have been expected to survive under the status quo.
The ICU Director commented that the best part of the Lean process was gathering everyone in the room at the same time, which allowed people to see the process as a whole and increased peer-group pressure to be part of the change process.
What do you think?
- How do you reach out to people in other departments to improve patient care outcomes
- What obstacles do you face
- What actions have you taken to overcome the obstacles
As always, I welcome your input to improve healthcare collaboration.
Kenneth H. Cohn
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